Patient Opinions on Electronic Messaging for STD Test Result Notifications

The majority of patients who chose to receive notification of STD results via electronic messaging, including via text message, and/or email, to be satisfactory and easy.

The majority of patients who chose to receive notification of sexually transmitted disease (STD) results via electronic messaging, including via text message, and/or email, to be satisfactory and easy (99.0% and 92.9%), according to a study published in Sexually Transmitted Diseases.

Many health departments are in need of affordable ways to improve local prevention efforts in the face of rising reports of infections with Neisseria gonorrhoeae and Chlamydia trachomatis. One mechanism to achieve this is to use a more efficient method for notifying patients of test results, encouraging treatment, partner notification, and follow-up appointments. To this end, the Durham County STD clinic in North Carolina implemented the use of Chexout in 2018. This software was designed to notify patients that test results are ready via text or email, as well as send 3-month rescreening reminders.

Regardless of test results, patients who opted in for electronic notification were sent a notification that included a link to a secure patient portal sponsored by Chexout, where they could view test results. Patients who had positive test results and had not been given presumptive therapy received a message that included the clinic’s phone number with recommendations to call and schedule an appointment; the message did not mention specific STDs or lab results. Within the Chexout portal, patients who tested positive were also provided with links to information about treatment options, advice for notifying partners, reinfection information, and information on the importance of 3-month rescreening.

Researchers attempted to interview every other patient within the opt-in and opt-out populations of patients requesting testing for Neisseria gonorrhoeae and Chlamydia trachomatis between May and June 2018. Among the total 634 patients who were tested, 530 opted in and 104 opted out. A randomly assigned 50% sample from each group (N=317; 265 opt-in; 52 opt-out) was selected for a follow-up phone survey. Forty-eight of these (15.1%) refused to participate (n=39 [14.7%] opt-in; n=9 [17.2%] opt-out), 126 (39.7%) could not be reached (n=113 [42.6%] opt-in; n=13 [25.0%] opt-out) and 143 (45.1%) were interviewed (n=113 [42.6%] opt-in; n=30 [57.7%] opt-out).

Compared with surveyed patients who opted-out, opt-in patients were younger (median: 27 vs 37 years, P =.002) and more likely to be women (57.5% vs 33.3%; P =.02). Although patients could call the clinic for results, most opt-in patients viewed results using the Chexout patient portal (86.7%). Opt-in patients reported electronic result notification by text or email to be easy to use (92.9%) and satisfactory (99.0%), with 11 patients remarking that they preferred this method to “playing phone tag” with clinic staff for results, and 9 who noted the benefit of being able to screenshot their results to show partners. Patients who opted out did so out of privacy concerns (56.7%), feeling they were not technologically savvy (30.0%), and not wanting to have “more text messages or emails” (6.7%). Among opt-out patients, 63% shared an email address with another person, and 56.7% shared a cell phone with another person.

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Study investigators concluded that “health departments constantly search for improvements to STD services that are both inexpensive and impactful. Increasingly, people rely on personal electronic devices to access information, including healthcare information. Leveraging this existing technology can enhance the flow of information between the STD clinic and the patient and ultimately improve patient care.”